When they enroll in the Medicare program, physicians self-designate their Medicare physician specialty on the Medicare enrollment application (CMS-855I or CMS-855O), or in the Internet-based Provider Enrollment, Chain and Ownership System (PECOS). CMS uses these Medicare physician specialty codes, which describe the specific/unique types of medicine that physicians (and certain other suppliers) practice, for...
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number on new Medicare cards for transactions like billing, eligibility status, and claim status....
Medical billing is a process that has only gotten more complicated as time has passed. The recent ICD-10 code changes have only increased the complexity and ensured that more mistakes will be made as offices try to get used to the new system.
CMS is authorized to make any necessary adjustments to the payments of a provider of services or supplier who shares a TIN with a provider of services or supplier that has an outstanding Medicare overpayment. The Secretary of Health and Human Services is authorized to adjust the payments of such a provider of services or...
Incident-to Billing for Mid-level Providers The concept of incident-to billing is not new to the industry. Services and treatments are reimbursed at a tiered fee schedule depending on what level of healthcare professional billed for the service. If a physician bills for the service, it would be paid at 100 percent of the fee...